Intersectional trends in poor mental health and health inequities across the US

Though mental distress poses a large and growing threat to population health, our understanding of how its social distribution has changed over time and what these changes imply for mental health equity is limited. To address this, we use data from the Behavioral Risk Factor Surveillance System to non-parametrically describe how age-standardized prevalence of frequent mental distress (FMD) and social inequities in FMD have changed in the United States between 1993 and 2019 for intersectional social groups defined by ethnicity, race, sex, educational attainment, and household poverty status. We find that age-standardized FMD prevalence has increased for almost all social groups, that health inequities between more and less privileged groups have mostly widened in absolute terms but narrowed relatively, and that relying solely on common group FMD summaries masks substantial heterogeneity across intersectional subgroups. Our findings show an urgent need to address the sociopolitical determinants of mental distress, prioritizing policies which would address the growing inequitable burden experienced by those less privileged. • Age-standardized prevalence of frequent mental distress has risen 71% since 1993. • Those in poverty consistently reported the highest FMD between 1993 and 2019. • 90% of intersectional social groups reported rising mental distress over time. • Common social groups exhibited substantial within-group heterogeneity in trends. • Social inequities mostly improved in relative terms but worsened absolutely.